Timeline: History of Health Reform in the U.S - Kaiser Family ...
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Timeline: History of Health Reform in the U.S.
VIEW: Early 1900's 1930 – 1934 1935 – 1939 1940 - 1945 1945 - 1949 1950 - 1954 1955 - 1959 1960 – 1964 1965 – 1969
1970 - 1974 1975 – 1979 1980 - 1984 1985 - 1989 1990 – 1994 1995 - 1999 2000 – 2004 2005 – 2009 2010Early 1900's
1912 1912
Teddy Roosevelt and his National Convention of Insurance Commissioners
Progressive party endorse develops first model of state law for regulating health
social insurance as part of insurance.
their platform, including health
insurance.
1915
The American Association for Labor Legislation
(AALL) publishes a draft bill for compulsory health
insurance and promotes campaigns in several states.
A few states show interest, but fail to enact as U.S.
enters into World War I. The idea draws initial
support from the AMA, but by 1920 AMA reverses
their position.
1921 1927
Women reformers persuade Congress to pass the Committee on the Costs
Sheppard-Towner Act, which provided matching of Medical Care forms to
funds to states for prenatal and child health centers. study the economic
Act expires in 1929 and is not reauthorized. organization of medical
care. Group is comprised
of economists,
physicians, public health
specialists, and other
major interest groups. Recommendations were
completed by 1932. While some members would not
support the recommendation for medical group
practice, the majority did endorse the idea, along
with voluntary health insurance.
1929 1929
Baylor Hospital introduces Great Depression years begin.
a pre-paid hospital
insurance plan for a
group of school teachers,
which is considered the
forerunner of future
nonprofit Blue Cross
plans.
1930 – 1934
National Health Insurance and the New Deal
Hard economic times called for social policies to secure employment, retirement, and medical care. President
Roosevelt appointed a committee to work on all these issues, but in the end did not risk the passage of the
Social Security Act to advance national health reform.For an overview on National Health Insurance and the New Deal, please see p. 2 of National Health
Insurance: A Brief History Of Reform Efforts In The U.S.
1929-39 1934
The Great Depression spans a decade, with 1933-34 FDR creates Committee on Economic Security to
being the worst years. address old-age and unemployment issues, as well
as medical care and insurance.1935 – 1939
National Health Insurance and the New Deal
President Roosevelt continued to support national health reform throughout his terms. His second push for
national health insurance came after the Social Security Act passed. However, the momentum from FDR’s
Technical Committee on Medical Care and a National Health Conference were not enough to overcome a
Congress that was no longer supportive of further government expansions.
For an overview on National Health Insurance and the New Deal, please see p. 2 of National Health
Insurance: A Brief History Of Reform Efforts In The U.S.
1935 1935
Committee on Economic Security issues final Social Security Act
recommendations, none of which explicitly address passed by Congress. The
national health insurance; however principles of Act includes grants for
health reform are outlined. Committee later issues Maternal and Child
unpublished report "Risks to Economic Security Health. These grants
Arising Out of Illness." restored many of the
programs established
under the Sheppard-
Towner Act and extended the role of the Children’s
Bureau to include not only maternal and child health
services, but other child welfare services as well.
1935 1935-36
FDR forms Interdepartmental Committee to National Health Survey conducted under the auspices
Coordinate Health and Welfare Activities. of the U.S. Public Health Service to assess the
nation's health and the underlying social and
Learn more about the Interdepartmental economic factors affecting health – the forerunner to
Committee. the National Health Interview Survey of today.
1937 1938
Technical Committee on Medical Care established National Health Conference convened in Washington,
under Interdepartmental Committee to Coordinate D.C.
Health and Welfare Activities; publishes its report, A
National Health Program in 1938.
1939
Sen. Wagner introduces National Health Bill
incorporating recommendations from the National
Health Conference. Proposal dies in committee.1939 1939
Physicians start to organize the first Blue Shield plans Department of Health and Human Services born as
to cover the costs of physician care. the Federal Security Agency bringing together federal
agencies concerned with health, welfare, and social
insurance.
1940 - 1945
1943 1943
War Labor Board rules wage freeze does not apply to Senators Wagner and Murray, along with
fringe benefits, including health insurance benefits. Representative Dingell introduce legislation as part of
broader vision to operate health insurance as part of
social security. Wagner-Murray-Dingell bill includes
provisions for universal comprehensive health
insurance along with other changes to social security
meant to move toward system of "cradle to grave"
social insurance.
1944 1944
FDR outlines 'economic bill of rights' including right Social Security Board calls for compulsory national
to adequate medical care and the opportunity to health insurance as part of the Social Security
achieve and enjoy good health in his State of the system.
Union address.
Access the text of FDR's 1944 State of the Union
address.1945 - 1949
National Health Insurance and the Fair Deal
President Truman picked up the mantle for a national health program just months after the end of World War
II. His election in 1948 appeared to be a mandate for national health insurance, but the opposition, using fear
of socialism, coupled with the power of southern Democrats who believed a federal role in health care might
require desegregation, effectively blocked all proposals.
For an overview on National Health Insurance and the Fair Deal, please see p. 3 of National Health
Insurance: A Brief History Of Reform Efforts In The U.S.
1946 1946
Truman sends health message to Congress. Revised Hill-Burton Act (Hospital Survey and Construction
Wagner-Murray-Dingell bill introduced to Congress Act) to fund the construction of hospitals passes. It
again. An alternative Senate bill (Taft-Smith-Ball bill) also prohibits discrimination on the basis of race,
authorizes grants to states for medical care of the religion, or national origin in the provision of hospital
poor. Neither bill gains traction. services, but allowed for "separate but equal"
facilities. The statute also required hospitals to
provide a "reasonable volume" of charitable care.
1947 1948
Truman, in another special message to Congress National Health Assembly convened in Washington,
calls for a National Health Program. Wagner-Murray- D.C., by the Federal Security Agency. Final report
Dingell bill and Taft bill both reintroduced. endorses voluntary health insurance, but reiterated
need for universal coverage.
1948 1949
AMA launches a national campaign against national Supreme Court upholds National Labor Relations
health insurance proposals. Board ruling that employee benefits can be included
in collective bargaining.1950 - 1954
1950 1951
National Conference on Aging is convened by Federal Joint Commission on the Accreditation of Hospitals
Security Agency. (JCAH) formed to improve the quality of hospital care
through the voluntary accreditation of hospitals.
1952 1953
Federal Security Agency proposes enactment of Federal Security Agency made a cabinet level agency,
health insurance for Social Security beneficiaries. renamed Department of Health Education and
Welfare (DHEW).
1954 1954
President Eisenhower proposes a federal reinsurance Revenue Act of 1954 excludes employers'
fund to enable private insurers to broaden the contributions to employee's health plans from taxable
groups of people they would cover. income.
1955 - 1959
1956 1956
Military "medicare" program enacted, providing Legislation introduced in the House (the Forand bill)
government health insurance for dependents of to provide health insurance for social security
those in the Armed Forces. beneficiaries; reintroduced again in 1959.
1957 1957
AFL-CIO decides to support government health First year that the National Health Interview Survey
insurance, while the AMA reiterates opposition to was conducted; survey has been continuously fielded
national health insurance. ever since.
1960 – 1964
The Great Society – Medicare and Medicaid
The groundwork for the enactment of Medicare and Medicaid began in the late 1950s and early 1960s. As
employer-based health coverage grew, private plans began to set premiums based on their experience with
health costs and the retired and disabled found it harder to get affordable coverage. Health reformers
refocused their efforts toward the elderly.
For an overview of this era in health reform history, please see p. 4-5 of National Health Insurance: A
Brief History Of Reform Efforts In The U.S.1960 1960 Federal Employees Health Benefit Plan (FEHBP) Kerr-Mills Act passes, using federal funds to support initiated to provide health insurance coverage to state programs providing medical care to the poor federal workers. and elderly; a precursor to the Medicaid program. 1961 1962 White House Conference on Aging is held in President Kennedy addresses the nation on Medicare Washington, D.C. Presidential task force recommends that is televised from Madison Square Garden. AMA health insurance for the elderly under Social Security issues televised rebuttal. and President Kennedy sends special message to Congress on health. Rep. King and Sen. Anderson Read text of President Kennedy's address at introduce a bill to create a government health Madison Square Garden. insurance program for the aged; King-Anderson bill draws support from organized labor, intense opposition from the AMA and commercial health insurance carriers.
1963 1964
Kennedy sends special message to Congress on President Johnson advocates for Medicare in a
needs of the elderly. King-Anderson bill special message to Congress.
re-introduced.
1964
Civil Rights Act passes.
1965 – 1969
The Great Society – Medicare and Medicaid
Medicare and Medicaid were incorporated under the Social Security Act and signed by President Johnson in
1965 with Truman by his side. The combination of Johnson’s political skills, a large Congressional Democratic
majority, public approval, the support of the hospital and insurance industries, and the fact that no government
cost controls or physician fee schedules were enacted contributed to the passage of the most significant health
reform of the century.
For an overview of this era in health reform history, please see p. 4-5 of National Health Insurance: A
Brief History Of Reform Efforts In The U.S.
1965 1965
1965 The Neighborhood health centers (precursors to Federally
Medicare and Qualified Health Centers or FQHCs) are established
Medicaid as part of the Office on Economic Opportunity to
programs are provide health and social services to poor and
signed into law. medically underserved communities.
Medicare Part A is
to pay for
hospital care and Access an overview of the role of community
limited skilled nursing and home health care. health centers.
Optional Medicare Part B is to help pay for physician
care. Medicaid is a separate program to assist states
in covering not only long-term care for the poor but
also to provide health insurance coverage for certain
1967
classes of the poor and disabled.
Social Security amendments pass, adding optional
Medicaid categories to insure others who are not
Learn more about the history of the Medicare
receiving cash assistance. Early and Periodic
program.
Screening and Diagnostic Testing (EPSDT) benefits
are also added to Medicaid.
Access the transcript of President Johnson's
remarks at his signing of Medicare and Medicaid.
Access the Foundation's fact sheet on the EPSDT
benefit.
For other historical materials visit the Foundation's
Medicare and Medicaid at 40.
1970 - 1974Competing National Health Insurance Proposals
General inflation and unchecked health care costs were a growing concern by the early 1970s. Sen. Kennedy’s
proposal for national health insurance was countered by President Nixon’s own Comprehensive Health
Insurance Plan (CHIP). Other Congressmen wrote more incremental plans, all of which splintered support for
any one reform. Action on national health insurance was eventually overshadowed by the Watergate hearings
and Nixon’s resignation. While President Ford supported national reform in 1974 and Rep. Mills drafted yet
another compromise bill, its progress stalled without Mills' leadership following a personal scandal.
For an overview of this era in health reform history, please see p. 5-6 of National Health Insurance: A
Brief History Of Reform Efforts In The U.S.
Access the transcript and audio recording of President Nixon's radio address concerning CHIP.
1971 1972
Wage and price freezes begin, with medical care Supplemental Security Income (SSI) program begins
singled out for specific limits on annual increases in providing cash assistance to elderly and disabled.
physician and hospital charges. Medical care limits States are required to cover SSI recipients or apply
are not lifted until 1974, over a year after other their 1972 Medicaid eligibility standards for the two
controls had ended. groups for coverage under Medicaid.
1972 1974
Social Security amendments pass allowing people Hawaii Prepaid Health Care Act passes requiring
under age 65 with long-term disabilities and end employers to cover any employee working more than
stage renal disease (ESRD) to qualify for Medicare 20 hours/week. In 1989 Hawaii added their State
coverage. Those with long-term disabilities must wait Health Insurance Program to cover "the gap group":
for two years before qualifying for Medicare. those not eligible for Medicaid or employer-based
insurance.
1974 1974
Employee Retirement Income Security Act (ERISA) Enactment of Health Planning Resources
exempts self-insured employers from state health Development Act, mandating states to develop
insurance regulations. Hawaii's new employer health planning programs to prevent duplication of
mandate is given an exemption from ERISA. services. Results in the widespread adoption of
Certificate of Need programs.1975 – 1979
Cost-Containment Trumps National Health Insurance
In the face of stagflation and rapidly rising health care costs, President Carter prioritizes health care cost
containment over expanding coverage. Sen. Kennedy, however, drafts another national health insurance
proposal, which is then followed by Carter's own plan that would delay implementation until 1983. National
health reform efforts were completely stalled in the face of an economic recession and uncontrollable health
care costs.
For an overview of this era in health reform history, please see p. 6-7 of National Health Insurance: A
Brief History Of Reform Efforts In The U.S.
1977 1977
Health Care Financing Administration (HCFA) President Carter proposes Medicaid expansion
established within Department of Health, Education, (Children's Health Assessment Program) for poor
and Welfare (HEW). children under age 6; proposal fails to come to a
vote in Congress.
Interview with Secretary Califano on the
establishment of HCFA Watch Video
1977
National Medical Care Expenditure Surveys (NMCES)
conducted surveying households, their physicians,
and health insurers – provides first detailed data on
individuals' health care costs.1980 - 1984
1980 1981
Department of Health, Education, and Welfare Federal budget reconciliation (OBRA 81) requires
renamed the Department of Health and Human states to make additional Medicaid payments to
Services (DHHS). hospitals who serve a disproportionate share of
Medicaid and low-income patients. It also repeals the
requirement that state Medicaid programs pay
hospital rates equivalent to those paid by the
Medicare program. Requires states to pay nursing
homes at rates that are "reasonable and adequate"
under the Boren Amendment (applied to hospitals
the following year).
1981 1982
Two types of Medicaid waivers are established under States allowed to expand Medicaid to children with
a budget reconciliation act (OBRA 81) allowing states disabilities who require institutional care but can be
to mandate managed care enrollment of certain cared for at home and would not otherwise qualify
Medicaid groups and to cover home and for Medicaid if not institutionalized; popularly
community-based long-term care for those at risk of referred to as the Katie Beckett option for the
being institutionalized. disabled child who garnered national attention on the
issue.
1983
Medicare introduces Diagnostic Related Groups
(DRGs) as a prospective payment system for hospital
payment.1985 - 1989
1986 1986
Emergency Medical Treatment and Active Labor Act COBRA (Consolidated Omnibus Budget Reconciliation
(EMTALA) requires hospitals participating in Medicare Act) contains specific regulations that allow
to screen and stabilize all persons who use their employees who lose their jobs to continue with their
emergency rooms regardless of ability to pay. health plan for 18 months.
1986 1987
Federal budget reconciliation (OBRA 86) gives states Census Bureau begins annual estimate of health
Medicaid option to cover infants, young children and insurance coverage in the United States with its
pregnant women up to 100% of the poverty level Current Population Survey finds 31 million uninsured
regardless of whether they receive public assistance. (13% of the population) in 1987.
Raised to 185% of the poverty level in legislation for
infants and pregnant women the following year.
OBRA 86 also allowed state Medicaid programs to
pay Medicare premiums and cost sharing for qualified
1987
Medicare beneficiaries under 100% of poverty
National Medical Expenditure Survey (NMES), built
(QMBs). (This was later required in 1989 and
on the NMCES 1977, is conducted with household
increased to certain Medicaid beneficiaries at 120%
information supplemented by surveys of medical and
of poverty in 1990).
health insurance providers used by respondents.
1988 1988
Medicare Catastrophic Coverage Act (MCCA) expands The Family Support Act requires states to extend 12
Medicare coverage to include prescription drugs and months of transitional Medicaid coverage to families
a cap on beneficiaries' out-of-pocket expenses. leaving welfare due to earnings from work.
However, many believed the costs that were to be
born by the elderly outweighed the benefits.
Responding to the ground swell of negative reaction,
the MCCA is repealed the following year, retracting
these major provisions. However, the requirement 1989
that states pay Medicare premiums and cost-sharing Federal budget reconciliation (OBRA 89) mandates
amounts for poor beneficiaries through Medicaid is coverage for pregnant women and children under
maintained. age 6, at 133% of the federal poverty level.
Learn more on the repeal of MCCA.
1990 – 1994
The Health Security Act
Making national health reform a priority early in his Presidency, Clinton proposed a "managed competition"
approach, sending a detailed plan to Congress in 1993. It called for universal coverage, employer and
individual mandates, competition between insurers, with government regulation to control costs. Support from
key stakeholders was often limited and conditional. The opposition was led largely by two groups: the Health
Insurance Association of America and the National Federation of Independent Businesses, both believing
reform would create hardship for their smaller members. Congressional Democrats were divided in their
support, and further splintered by a variety of alternative proposals that were then generated all of which
blocked progress on the President's plan.For an overview of this era in health reform history, please see p. 7-8 of National Health Insurance: A
Brief History Of Reform Efforts In The U.S.
1990 1990
Federal budget reconciliation (OBRA 90) legislation National Committee on Quality Assurance (NCQA)
mandates Medicaid coverage of children age 6-18 forms to accredit managed care health plans.
under poverty level, phased in one year at a time
until 2002.
1993
Within his first week in office President Clinton
convenes White House Task Force on Health Reform,
and appoints First Lady Hillary Clinton as chair.
1993 1993
President Clinton's proposal, named the Health The Clinton Administration begins approving
Security Act, is introduced in both houses of Medicaid waivers allowing more statewide expansion
Congress in November, but gains little support. Every demonstrations. Many states turned to managed care
American would have a "Health Security Card" to for delivery of services and used savings to expand
ensure access to care. to previously uninsured groups.
1993 1993
The Vaccines for Children program providing federally Health Insurance Association of America begins
purchased vaccines to states is established. airing "Harry and Louise" television advertisements
portraying a middle-class couple worried about
health care under the Clinton health plan.
1993
Other national health reform proposals are
introduced in Congress, but also fail to garner
sufficient support for passage -- the
McDermott/Wellstone single payer health insurance
proposal and Cooper's proposal for managed
competition without a guarantee of universal
coverage. By mid-1994 even a bipartisan bill to
expand coverage without comprehensive reform is
unable to pass.1995 - 1999
1996 1996
Health Insurance Portability and Accountability Act Personal Responsibility and Work Opportunity Act
(HIPAA) restricts use of pre-existing conditions in delinks Medicaid and cash assistance eligibility and
health insurance coverage determinations, sets allows states to cover parents and children at current
standards for medical records privacy, and Aid to Families with Dependent Children (AFDC)
establishes tax-favored treatment of long-term care levels and higher. Bans Medicaid coverage of legal
insurance. immigrants within their first five years in the country,
except for emergency care.
Access resources on Welfare, Work, and
Health Care.
1996 1996
Mental Health Parity Act enacted that prohibits group Medical Expenditure Panel Survey (MEPS) is
health plans from having lower annual or lifetime conducted. Unlike its survey predecessors, the 1977
dollar limits for mental health benefits than medical NMCES and 1987 NMES, MEPS is designed to be
or surgical benefits (except substance abuse and ongoing, providing annual updates on health
chemical dependency). insurance coverage, access to care, utilization of
health services and their costs.
1997 1997
Census Bureau's Current Population Survey estimates Also part of the Balanced Budget Act (BBA), the
42.4 million (15.7% of the population) uninsured in State Children's Health Insurance Program (S-CHIP)
the United States. is enacted. Provides block grants to states allowing
for coverage of low-income children above Medicaid
Balanced Budget Act includes many changes in eligibility levels. BBA also allows states to cover
provider payments to slow the growth in Medicare working disabled with incomes up to 250% of
spending. It establishes the Medicare + Choice poverty, permits mandatory Medicaid enrollment in
program, a new structure for Medicare HMOs and managed care and repeals the Boren amendment.
other private plans offered to beneficiaries, later
re-named Medicare Advantage in 2003.
1999
Ticket to Work and Work Incentives Improvement
Act of 1999 allows states to cover working disabled
with incomes above 250% of poverty and impose
income-related premiums.2000 – 2004
2000 2002
Breast and Cervical Cancer Treatment and Prevention President Bush launches Health Center Growth
Act of 2000 allows states to provide Medicaid Initiative significantly expanding the number of
coverage to uninsured women for treatment of community health centers serving the medically
breast or cervical cancer if they have been diagnosed underserved.
through a CDC screening program, regardless of
income or resources. Learn more about the role of community health
centers in communities..
2003 2003
Maine passes the Dirigo Health Reform Act, a Medicare Drug, Improvement, and Modernization Act
comprehensive health care reform plan, that creates (MMA) passes, creating a voluntary, subsidized
the DirigoChoice health plan, providing subsidized prescription drug benefit under Medicare,
coverage to individuals and small employers, administered exclusively through private plans, both
expands Medicaid, and creates the Maine Quality stand-along prescription drug plans and Medicare
Forum. Advantage plans.
2003
Medicare legislation creates Health Savings Accounts
which allow individuals to set aside pre-tax dollars to
pay for current and future medical expenses. The
plans must be used in conjunction with a high
deductible health plan.2005 – 2009
2005 2006
Deficit Reduction Act of 2005 makes significant Medicare Part D Drug benefit goes into effect in
changes to Medicaid related to premiums and cost January.
sharing, benefits, and asset transfers.
2006 2006
Massachusetts passes and implements legislation to One month following Massachusetts, Vermont passes
provide health care coverage to nearly all state comprehensive health care reform also aiming for
residents. Legislation requires residents to obtain near-universal coverage. In addition to creating the
health insurance coverage and calls for shared Catamount Health Plan for uninsured residents, the
responsibility among individuals, employers, and the plan focuses on improving overall quality of care and
government in financing the expanded coverage. the management of chronic conditions through the
Within two years of implementation the state's Blueprint for Health.
uninsured rate is cut in half.
Learn more about Vermont's health reform.
Learn more about Massachusetts health reform:
Fact Sheet
News Clips
2006
City of San Francisco creates the Healthy San
Francisco program, providing universal access to
health services in the city for residents. A
controversial provision requiring city employers to
spend a minimum amount per hour on healthcare for
their employees is challenged in court. In September
2008, the U.S. Ninth Circuit Court of Appeals upholds
the employer requirement saying it does not violate
the Employee Retirement and Income Security Act of
1974 (ERISA).
Learn more about San Francisco's plan.
2007
Senators Wyden and Bennett introduce the Healthy
Americans Act. Proposal would require individuals to
obtain private health insurance coverage through
state health insurance purchasing pools. The
long-standing favorable tax treatment of employer-
sponsored insurance premiums would be eliminated.
Legislation gains some bipartisan support.2007 2007
Census Bureau estimates 45.6 million uninsured Congress passes two versions of a bill to reauthorize
(15.3% of the population) in 2007. Survey the State Children’s Health Insurance Program with
instrument undergoes periodic design improvements bi-partisan support, but President Bush vetoes both
over the years that confound trend analyses, yet bills and Congress cannot override the veto. A
remains the most widely used estimate of health temporary extension of the program is passed in
insurance coverage. December 2007.
For more on the nation's uninsured see the
Foundation's fact sheet and primer on the
uninsured.
2007
California fails in its attempt to pass a health reform
President Bush announces health reform plan that
plan with an individual mandate and shared
would replace the current tax preference for
responsibility for financing the costs. Compromise
employer-sponsored insurance with a standard
legislation supported by the Governor passes the
health care deduction. Proposal is not acted upon by
Assembly, but falls short in the Senate.
Congress.
2008
Mental Health Parity Act amended to require full
parity. Insurance companies must treat mental health
conditions, including substance abuse disorders, on
an equal basis with physical conditions when health
policies cover both.
2008 2008
Presidential campaign focuses early on national Sen. Baucus, Chairman of the Senate Finance
health reform, overshadowed later by housing crisis Committee, releases White Paper on health reform
and economic downturn, yet remains a key outlining a national health reform plan based on the
pocketbook issue throughout the campaign. Both Massachusetts model.
major party candidates announce comprehensive
health reform proposals.
2009
President Obama establishes Office of Health Reform
to coordinate administrative efforts on national
health reform.
2009 2009
The Children's Health Insurance Program (CHIP) is The American Reinvestment and Recovery Act
reauthorized, providing states with additional (ARRA) makes substantial investments to help
funding, new tools land fiscal incentives to help develop health information technology, expand the
reach and estimated 4.1 million children through primary care workforce and conduct research on
Medicaid and CHIP who otherwise would have been comparative effectiveness for health care treatment
uninsured by 2013. options.
Learn more about the program's reauthorization
history.
2009
Learn more about the role Medicaid and SCHIP play
White House holds a Health Reform Summit with keyin covering low-income children: Enrolling stakeholders.
Uninsured Low-Income Children in Medicaid
and SCHIP and
Health Coverage of Children: The Role of
Medicaid and SCHIP
2009
President Obama releases FY 2010 budget which
outlines eight principles for health reform and
proposes a set aside of 634 billion in a health reform
reserve fund.
2009
Congress continues to deliberate national health
reform options.2010
National Health Reform Enacted
February 22, 2010 February 25, 2010
The White House releases President Obama's President Obama hosts a second Health Care
proposal for health care reform that bridges Summit at Blair House. Little consensus achieved
elements of the House and Senate bills passed in the between the Democrats and Republicans
last months of 2009.
March 3, 2010
In a White House speech President Obama lays
out his proposal and provides legislative direction
indicating that if need be, the reconciliation process
(requiring a Senate majority vote vs. 60 votes to
pass) should be used to pass major health reform
legislation.
March 21, 2010 March 23, 2010
The House of Representatives passes the Senate bill,
the Patient Protection and Affordable Care Act
(voting 219-212) and sends it to the President for
signature.
House also passes the Health Care and Education
Reconciliation Act of 2010 that amends the Senate
bill to reflect House and Senate negotiations and also
includes reform of the nation's student loan system.
The reconciliation bill is sent to the Senate for a final
vote.
Official summary of the Senate bill.
President Obama signs the landmark legislation, the
An official summary of the reconciliation bil Patient Protection and Affordable Care Act (P.L.
111-148) at the White House, surrounded by
legislative leaders and invited guests, including some
who have suffered from lack of health coverage.
The historic health reform legislation requires that all
individuals have health insurance beginning in 2014.
The poorest will be covered under a
Medicaid expansion.
Those with low and middle incomes who do
not have access to affordable coverage
through their jobs will be able to purchase
coverage with federal subsidies through new
"American Health Benefit Exchanges."
Employers are not mandated to provide
health benefits, however large businesses
whose employees receive insurance
subsidies will pay penalties. Small businesses
will be able to access more plans through a
separate Exchange.
Health plans will not be allowed to denycoverage to people for any reason, including
their health status, nor can they charge
March 25, 2010
more because of a person's health or gender. Senate passes final version of the Health Care and
Young adults will now have the option of Education Reconciliation Act of 2010 with two
being covered under their parents' plan up to education-related changes to the House bill (voting
age 26. 56-43). House votes on the bill as amended by the
Senate (voting 220-207).
President Obama's speech at the signing
March 30, 2010
President Obama signs the Health Care and
Education Reconciliation Act of 2010 (becoming P.L.
111-152) at the Northern Virginia Community
College amending P.L. 111-148.
For a summary of the key provisions:
www.kff.org/healthreform/upload
/8023-R.pdf
Check out our implementation timeline, an
interactive tool designed to explain how and when
the provisions of the health reform law will be
implemented over the next several years.You can also read
